title: Video-assisted pericardioscopic surgery for epimyocardial lead implantation.
abstract: OBJECTIVE
  Video-assisted pericardioscopic surgery (VAPS) for epimyocardial lead implantation has demonstrated positive acute results concerning the safety and degree of freedom inside the pericardium. We evaluated the employment of a newly developed trocar for pericardioscopy with regard to long-term effects and feasibility of reoperation.
  
  
  METHODS
  Eight adult sheep were divided into three groups. In two animals, VAPS was used exclusively. All other animals received four small-caliber epicardial leads through VAPS. After 6 and 12 months (n = 3 each), reoperation was conducted for reevaluation of entry site, intrapericardial adhesions, lead position, and morphology of the implantation site.
  
  
  RESULTS
  Reentry close to the previous entry site proves unproblematic. Adhesions were mild to moderate in the immediate area of the implanted leads. Throughout the follow-up, pacing parameters were satisfactory. Lead dislodgement occurred in 1 of 24 leads. The deployment of small-caliber flexible endoscopes through the new trocar provided sufficient navigation, stability, and maneuverability.
  
  
  CONCLUSIONS
  Reoperation from the same subxiphoid approach proved feasible. Lead removal and reimplantation were feasible at both 6 months and 12 months after initial implantation. The intrapericardial adhesions caused by VAPS alone are mild.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, University Hospital, Medical Faculty RWTH Aachen, Aachen, Germany. nhatam@ukaachen.de
authors.forename: Nima
authors.initials: N
authors.lastname: Hatam
authors.forename: Jan
authors.initials: J
authors.lastname: Spillner
authors.forename: Eva Maria
authors.initials: EM
authors.lastname: Nosthoff
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Moza
authors.forename: Mark
authors.initials: M
authors.lastname: Lazeroms
authors.forename: Karl
authors.initials: K
authors.lastname: Mischke
authors.forename: Patrick
authors.initials: P
authors.lastname: Schauerte
authors.forename: Ruediger
authors.initials: R
authors.lastname: Autschbach
authors.forename: Andreas
authors.initials: A
authors.lastname: Goetzenich
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004567:Electrodes, Implanted; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000628:therapy*; D015994:Incidence; D010496:Pericardium / Q000601:surgery*; D012756:Sheep; D013997:Time Factors; D000267:Tissue Adhesions / Q000453:epidemiology / Q000473:pathology; D020535:Video-Assisted Surgery / Q000379:methods*